Integrating personal budgets for people with mental health problems

09 December 2014

A different question: 'What’s the matter with you?' changes to 'What matters to you?'

A new resource is launched today, supporting staff who are doing pioneering work with mental health personal budgets. In many parts of the country, health and social care organisations are putting people in control of their wellbeing through integrated personal budgets.

The new guide from the Social Care Institute for Excellence (SCIE), developed with our colleagues in the Think Local Act Personal (TLAP) partnership, says that creating a joined-up, integrated experience of health and social care services is vital to achieve good outcomes for people with mental health conditions. The guide has been written for professionals, charged with integrating personal budgets for adults of working age with mental health problems.

The guide gives an overview of the terminology and current policy background; it also examines the key areas that need to be tackled for integration to become a reality; and it makes recommendations for implementing integrated personal budgets in mental health.

Daniel's story

A young man stars in a film that’s embedded on the site and on YouTube. Daniel, who has a diagnosis of paranoid schizophrenia, says his personal budget has done wonders for him. Traditional types of spending on his mental health didn’t provide good outcomes. However, his new personal budget has helped him to get fit, at a time when he had put on weight; and it helped him to be flexible with college work.

In the film, Daniel says:

The personal budget has definitely helped me to improve my mental health and my health physically as well. It has helped me towards recovery.

SCIE’s Chief Executive, Tony Hunter, says:

Daniel’s experience shows that using a personalised approach to mental health care and support can really help the person; in ways that traditional methods haven’t always managed. Any new way of working can be challenging but that’s no reason not to do it; managers and staff need to prepare for unconventional ways of using a budget, but if this provides value-for-money and improved lives for people, these methods need to be considered.

Simon Stevens, Chief Executive, NHS England, says:

I welcome the publication, which draws on practical experiences of delivering integrated personal budgets in mental health, and the difference they have made to the lives of people involved. NHS England is committed to supporting this, and to making the aspiration for integrated and personalised services a reality for people with mental health needs. We want to move the conversation on from just 'what’s the matter with you?' to 'what matters to you?' If we can do that, we will create new forms of partnership with people and communities, and meet our shared challenges far better.

Mental health personal health budgets (PHBs) have been piloted for several years*; now, people eligible for NHS Continuing Healthcare have a right to one. The NHS recently launched the Integrated Personal Commissioning Programme (IPC) to increase the number of people receiving a personal health budget, including people with severe and enduring mental health problems.

Some of the recommendations in the report include:

  • Staff should support people in positive risk-taking
  • Managers must offer guidance and support, showing their commitment to personalisation and risk enablement
  • Brokerage and peer support: Commissioners should consider funding for voluntary and community organisations, to offer brokerage and peer support which enables more users to benefit from personal budgets
  • Pooled budgets make the whole process of integrated personal budgets more straightforward for both mental health practitioners and users.

*West Sussex

West Sussex has had integrated mental health teams for over ten years for adults of working age. Currently, West Sussex has approximately 150 integrated personal budgets in place for people with substantial or critical needs. Care coordinators – community psychiatric nurses, social workers and occupational therapists – have been working generically for a long time and are used to working across professional boundaries. They do the assessment and budget allocation, and voluntary sector providers usually then work with the individual to come up with a support plan within the personal budget. In general, West Sussex staff now use a much broader range of voluntary sector providers. Because of a pooled budget, care coordinators do not need to specify which needs are related to health and which are related to social care.

Policy context

There has been a coming together of NHS and social care perspectives over the years, but more work is needed to forge a culture that is truly integrated between the two organisations. SCIE was commissioned to produce this guide by the Department of Health as part of its overall policy of increasing the provision and take-up of personal budgets across health and social care, and more specifically in the mental health field. PHBs are a key part of NHS England’s current Integrated Personalised Commissioning initiative.

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